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Joined 1 year ago
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Cake day: June 10th, 2023

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  • All very valid points and part of why American health insurance is such a joke

    I had an incident recently where my spouse had to go to the ER because of a life threatening incident. One of those fix it right now or they might die things. (They’re fine now, thank goodness.)

    We went to an in-network hospital and all doctors were also in-network. However the one who actually did the life-saving procedure was a specialist. Under our insurance plan seeing a specialist requires a referral, which of course we didn’t have time to get. So insurance tried to nope out of that doctor’s entire bill.


  • You need to know both your deductible and out of pocket maximum numbers. You’ve said your deductible is $1500. For the sake of this example let’s say your out of pocket max (OOP from now on) is $2500.

    For simplicity, we’ll go with your insurance’s negotiated rate for the procedure is $1000*. Meaning at the end of the day you and your insurance combined will pay the hospital $1000.

    Basically any bills up to $1500 for the year you pay 100%. Between $1500 and $2500 (or your OOP), insurance pays 50% and you pay 50%. Over $2500 insurance pays 100%.

    Some examples to illustrate:

    1. You’ve paid $400 this year so far. You pay the full $1000: $400 + $1000 = $1400 which is less than your deductible of $1500
    2. You’ve paid $1000 so far this year. You pay $750 and insurance pays $250: $500 gets you to the $1500 deductible limit so you have to pay all that, plus you pay 50% of the remaining $500 bill = $250.
    3. You’ve paid $1700 so far. You pay $500 and insurance pays $500. $1700 + $500 = $2200 which is less than your OOP of $2500
    4. You’ve paid $2300 so far. You pay $200 and insurance pays $800. 50% of $1000 = $500 but $500 would put you over your OOP of $2500. $2500 - $2300 = $200. You pay $200 and insurance pays the rest.
    5. You’ve paid $2500 so far. Insurance pays $1000
    • If your insurance’s negotiated rate for the procedure is $1000, this means that’s what the hospital and insurance have agreed to pay. A lot of times you’ll see the hospital “charge” a larger number and then have an insurance “discount” but ignore this. It doesn’t factor into deductible or out of pocket maximum calculations.








  • Also, lawyer up asap.

    If you’re in the US, absolutely this. My back was injured on the job, took the work comp doctors almost 6 months to figure that out, and when they did my employer fired me. Then worker’s comp tried to say they didn’t need to pay anything and tried to close my case.

    Up until that point I had resisted getting a lawyer, naively trusting the system (I was young, and I had no back issues before so I honestly thought common sense would prevail). My lawyer’s fees were a percent of whatever the final settlement was (30% iirc but this was over a decade ago). It took more than 2 years from when I got injured to come to a settlement.

    I do have chronic pain and have had to change or give up certain parts of my life. But once the worker’s comp case was closed I could finally choose my own doctors, and my pain is much more manageable because of it.

    Probably not the triumphant story you were looking for, but you can get through this. It doesn’t seem like it now, I remember being in the thick of it. My pain was so bad I couldn’t sleep, and the worker’s comp doctor told me I “just needed to take some Tylenol.”

    It won’t always be this way. Just remember that, and get a lawyer.






  • When mine was young I only gave him dry food. Then he developed kidney disease (CKD) 4 years ago. It and diabetes are fairly common in older cats.

    Now he gets dry food plus wet food in the morning and evening - 1/2 of a little can or 1/4 of a bigger can at each feeding. The dry food and wet food are in separate bowls. That plus finding a water fountain he likes has so far kept his kidney disease from getting any worse.

    Next cat I’ll give wet and dry food from the start.